This invention is in the field of surgical tools for shaping bones, for purposes such as repairing or replacing damaged cartilage in mammalian joints.
In certain types of surgery (including but not limited to orthopedic surgery to repair damaged cartilage in a knee, hip, shoulder, or other joint), it is necessary to prepare a bone surface, before the surface can receive and support an implant in a stable, secure manner that preferably will last for decades. In such surgery, arthroscopic or other “minimally-invasive” methods and tools generally are preferred whenever possible, since they minimize tissue damage, recovery times, etc.
Relevant art in the field of arthroscopic tools that can be used to manipulate bone surfaces (and other types of minimally invasive tools, for manipulating other types of internal tissues) can be found in numerous US patents in various subclasses within Class 606, including subclasses 79, 80, and 96; Examples include U.S. Pat. No. 6,884,246 (Sonnabend et al 2005), U.S. Pat. No. 6,120,507 (Allard et al 2000), U.S. Pat. No. 6,358,253 (Torrie et al 2002), and U.S. Pat. No. 5,817,095 (Smith 1998). However, most such art involves items that are either: (i) designed to create holes for anchoring devices, or for similar non-planar sculpting of bones surfaces; or, (ii) designed for use in “open joint” surgery, rather than arthroscopic surgery. The Applicant herein is not aware of any patents or articles describing tools having designs comparable to those shown herein, to facilitate the arthroscopic preparation of a smooth (or “planed”) bone surface, or for similar uses with other tissues.
Various other types of tools have been developed for arthroscopic, laparoscopic, and other types of minimally-invasive surgery, and they are illustrated in the catalogs and websites of various tool sellers, including Smith and Nephew (www.smith-nephew.com) and Stryker (www.stryker.com). The most relevant tool known to the Applicant herein is usually called a “rotary basket punch”. It uses a scissors-type grip, or a rotational squeeze-operated grip, with a long thin shaft containing a rotating rod inside a nonrotating sleeve. At the end is a small sharp blade affixed to the rotating rod. When a surgeon squeezes the scissors-type grip, a gear mechanism causes the rod to rotate, which causes the blade at the end to pass through an arc of travel. In this manner, the blade will cut through a rounded arc of soft tissue, such as for biopsy removal, to cut away a piece of torn cartilage, etc. That tool is of interest, because of the gearing mechanism that causes the manipulator device at the “working end” of the tool (i.e., the tip of the tool that enters a patients body or limb) to pass through a circular arc, when the grip is squeezed and closed by a surgeon. However, the existence of a rotating component, in a rotary basket punch tool, is the only substantial similarity between that type of prior art tool, and the new types of tools described below.
Several terms need to be clarified at this point, and it should be understood that other similar or analogous terms can also be used if desired. These terms are intended to be used in common and conventional ways, as used by surgeons who use these types of tools. However, it should be noted that the usage of some terms, including usage among surgeons and in articles and textbooks, can vary, in ways that usually reflect various lay meanings and inferences. As one example, some people and articles refer to the “handle” of a tool as including that portion of a tool shaft which does not enter a person's body or limb, as well as any other appurtenances that are intended for gripping and that are coupled to the toolshaft. However, other people and articles refer to the “handle” of a tool as excluding any portion of a tool shaft, and being limited only to gripping components that are coupled to a tool shaft. As another example, some people refer to a mammalian “body” as including only the shoulders, chest, abdomen, hips, etc; other also include the head but not the limbs; and other also include the limbs. Those types of differences and distinctions are merely semantic in nature, and anyone who understands how such tools function and are used can readily interpret and understand how the various terms used herein can be applied to the modified tools described and illustrated herein.
As used herein, “handle” (which could also be referred to as the grip, base, etc.) includes any portion of a tool that a surgeon can use to grip, move, and otherwise manipulate the tool. In minimally-invasive surgery, the handle normally remains outside the patient's body. If desired, a handle can include or be supplemented by one or more attachments, such as one or more gripping handles oriented perpendicular or otherwise angled with respect to the tool shaft (as in the types of rotary basket punches mentioned above), to provide a surgeon with better control over positioning, motion, and rotation of the tool.
The term “handle end” is also used herein in a broad sense. It is not limited to the very tip (or base) of a handle; instead, as used herein, a tool having a shaft should generally be understood as being divided into three portions, which are the handle end, the working end, and some length of shaft which separates the handle end, from the working end.
As use herein, the “base” of a handle is also used broadly. It is not limited to a single component that actually touches and sits next to a cable end, from a drive unit. Instead, it can include additional components that form an assembly that occupies the end of a handle. The specific component that actually touches the end component of a flexible cable from a drive unit, when the tool is coupled to such a drive unit, can be called the root, the collar, or similar terms.
A drive unit is a mechanical system that remains outside a patient's body, which provides one or more flexible cables that can provide drive power, and suction capability, to any suitable tool affixed to the end of such a cable. Suitable drive units, made by companies such as Smith & Nephew or Stryker, are well-known, and are already owned and used by any hospital or clinic where orthopedic surgery is routinely done. Each of those two companies uses its own proprietary interface at the ends of its drive cables, to promote the sale and use of tool heads made and sold by that company. Accordingly, any tool described herein should be designed to be coupled to a type of drive interface that already is in widespread use among hospitals and clinics.
The terms “head”, “working head”, and “tip” are used interchangeably herein, to refer to a device (which in most cases will be an assembly or subassembly) positioned at or near the tip of the shaft. This subassembly will enter a patient's body, when the tool is in use. It typically will include one or more components such as a grinding burr, one or more blades, the tip of a suction tube, a cautery device, any cowl component(s) that may be present, any adjustable or other appurtenances that are mounted to or that interact with the cowl component, etc. As used herein, “cautery” can also be called coagulation, and it can use either electrical voltage or radiofrequency energy to close and seal blood vessels, etc.
The term “manipulator component” refers to a component at the working end of a tool, which alters or otherwise manipulates tissue, usually by means of direct contact (such as a burr, blade, pincher, etc.), or by emitting heat or other energy (such as a cautery tip, often referred to by surgeons as “Bovies”, after a widely-used brand of cautery tips).
The term “sleeve” is used to refer to any and all non-rotating, non-drive-belt components that are positioned between a tool handle or base, and the working head of the tool. The sleeve normally will include or provide suction means, and it will enclose and protect a drive mechanism. Most rotating devices are driven by a rotating shaft, flexible drive belt, miniaturized motor, etc.; it should also be noted that reciprocal or other forms of motion can be used to carry out a planing or similar procedure, if desired, and such motion can be provided by other types of miniaturized systems.
Terms such as “cylindrical” and “generally cylindrical” are used interchangeably herein, for convenience, and include any type of grinding burr that has a surface shape designed to rotate around a longitudinal axis, when performing a planing-type procedure. Such burrs can have modified cylindrical shapes (such as, for example, cylinders having convex or concave shapes). Similarly, a cylindrical burr can have a combination of both (i) an abrasive or grinding surface, and (ii) a smooth and nonabrasive surface, which can have an enlarged diameter if desired, to serve as a “stop”, detente, or other type of positioning or control device.
Planing Tools
One primary focus of this invention is on planing tools that which can be used to prepare a bone surface so that it is ready to receive and stably support a prosthetic implant. As used herein, terms such as “planed” or “planar” refer to a bone surface that has been prepared (or worked, machined, treated, or similar terms) in a manner that provides it with a relatively smooth surface. A planed surface generally should be free of burrs, ridges, protrusions, crevices, and other irregularities that could interfere with stable and durable anchoring (or fixation, attachment, etc.) of a prosthetic device to the bone surface. As used herein, terms such as planing, planed, or planar are not limited to the mathematical definition of a plane, which refers to a truly flat and two-dimensional surface. Instead, planing tools also can be used to prepared smooth rounded surfaces on the condyles or other rounded portions of various bones, as occur on femoral runners, in ball-and-socket joints such as hips and shoulders, and in other types of joints. Terms such as “rounded” or “curved” are not limited herein to spherical shapes, and can includes shapes such as cylindrical, elliptical, curvilinear, etc.
Accordingly, the term “planing tools” as used herein refers to tools designed to create relatively smooth flat, rounded, or curved surfaces on bones, including but not limited to bone surfaces that are being prepared to receive and support surgical implants. Planing tools are different and distinct from tools such as drills, routers, etc., which are used mainly to create alterations (such as holes, grooves, etc.) in a prepared surface. However, it should be noted that at least some types of planing tools also can be referred to by other terms, such as “shaving tools” or “shavers”. The use of that term arises from the similarities between surgical shavers, and the types of shavers used to remove whiskers, leg hair, etc., to leave behind smooth-looking skin.
For purposes of illustration, the description below focuses on tools that can be used for arthroscopic preparation of bone surfaces that will receive implants designed to repair or replace damaged cartilage, in joints such as knees, hips, shoulders, etc. It will be recognized by those skilled in the art that these types of tools also can be adapted and used for other types of surgery as well, including spinal surgery, surgery to correct genetic malformations or bone-related diseases or injuries, surgery to implant other types of medical devices (such as devices for electrostimulation of muscles or nerves, devices for long-term drug release, devices to sequester transplanted cells to prevent immune rejection, etc.), and surgery to remove or alter the shapes of benign tumors and other unwanted growths.
In particular, it should be noted and emphasized that certain embodiments described below can be adapted for use on a variety of tools used today in a wide variety of arthroscopic, laparoscopic, exploratory, biopsy-gathering, and other surgical procedures. In general, these new types of tools provide an “extendible manipulator component” that can be extended in a linear direction, under the control of a surgeon, beyond their initial mounting or entry position. Accordingly, this new class of mechanisms can allow a surgeon to move an extendible device such as a suction tube, a cautery tip, or a set of pinchers, some distance (such as up to a centimeter or more) beyond what would otherwise be the “working tip” of a nonextendible manipulator component, such as a grinding burr or a shaver orifice. As will be recognized by surgeons, the ability to temporarily extend a device such as a suction tube, cautery tip, or set of pinchers, out beyond the normal tip of a tool, whenever desired during a surgical operation, can enable a number of new and highly useful functions that extend well beyond repairing cartilage, or preparing bone surfaces to receive implants.
Accordingly, one object of this invention is to disclose a new class of planing tools for arthroscopic, orthopedic, or other surgical use, to create smoothed bone surfaces (which can be flat, rounded, or curvilinear) that can support the anchoring of cartilage-repair or other surgical implants.
Another object of this invention is to disclose new methods for creating or improving flat or smoothly-rounded surfaces on bones, prior to implantation of surgical or medical devices, such as cartilage repair implants.
Another object of this invention is to disclose a new class of tools for creating or improving flat or smoothly-rounded surfaces, on various types of tissues other than bones.
Another object of this invention is to disclose a new class of surgical tools that have an additional functional device (such as a suction tube, cautery device, or set of pinchers) that can be extended beyond the normal nonextendible working tip of the tool, under the control of a surgeon.
These and other objects of the invention will become more apparent through the following summary, drawings, and description.